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KERISA SUE ELLOWAY D.D.S.

Pediatric Dentistry >> Dentist >> Dental Providers

Registrant NPI Number: 1154452324

Individual Registrant:
 KERISA SUE ELLOWAY D.D.S.
Gender: F
Sole Proprietor

Location and contact information for practice:
1730 MAIN ST SUITE A FORTUNA, CA 95540-2451 US
Tel: 707-725-1303  Fax: 707-725-1358

Contact information for business:
1730 MAIN ST STE A  FORTUNA, CA 95540-2451 US
Tel: 707-725-1303  Fax: 707-725-1358

Registration Information:
NPI: 1154452324
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Dentist
Pediatric Dentistry
CA47254

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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